Alcohol use and burden for 195 countries and territories, 1990-2016 : a systematic analysis for the Global Burden of Disease Study 2016

Background Alcohol use is a leading risk factor for death and disability, but its overall association with health remains complex given the possible protective effects of moderate alcohol consumption on some conditions. With our comprehensive approach to health accounting within the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, we generated improved estimates of alcohol use and alcohol-attributable deaths and disability-adjusted life-years (DALYs) for 195 locations from 1990 to 2016, for both sexes and for 5-year age groups between the ages of 15 years and 95 years and older. Methods Using 694 data sources of individual and population-level alcohol consumption, along with 592 prospective and retrospective studies on the risk of alcohol use, we produced estimates of the prevalence of current drinking, abstention, the distribution of alcohol consumption among current drinkers in standard drinks daily (defined as 10 g of pure ethyl alcohol), and alcohol-attributable deaths and DALYs. We made several methodological improvements compared with previous estimates: first, we adjusted alcohol sales estimates to take into account tourist and unrecorded consumption; second, we did a new meta-analysis of relative risks for 23 health outcomes associated with alcohol use; and third, we developed a new method to quantify the level of alcohol consumption that minimises the overall risk to individual health. Findings Globally, alcohol use was the seventh leading risk factor for both deaths and DALYs in 2016, accounting for 2.2% (95% uncertainty interval [UI] 1.5-3.0) of age-standardised female deaths and 6.8% (5.8-8.0) of age-standardised male deaths. Among the population aged 15-49 years, alcohol use was the leading risk factor globally in 2016, with 3.8% (95% UI 3.2-4-3) of female deaths and 12.2% (10.8-13-6) of male deaths attributable to alcohol use. For the population aged 15-49 years, female attributable DALYs were 2.3% (95% UI 2.0-2.6) and male attributable DALYs were 8.9% (7.8-9.9). The three leading causes of attributable deaths in this age group were tuberculosis (1.4% [95% UI 1. 0-1. 7] of total deaths), road injuries (1.2% [0.7-1.9]), and self-harm (1.1% [0.6-1.5]). For populations aged 50 years and older, cancers accounted for a large proportion of total alcohol-attributable deaths in 2016, constituting 27.1% (95% UI 21.2-33.3) of total alcohol-attributable female deaths and 18.9% (15.3-22.6) of male deaths. The level of alcohol consumption that minimised harm across health outcomes was zero (95% UI 0.0-0.8) standard drinks per week. Interpretation Alcohol use is a leading risk factor for global disease burden and causes substantial health loss. We found that the risk of all-cause mortality, and of cancers specifically, rises with increasing levels of consumption, and the level of consumption that minimises health loss is zero. These results suggest that alcohol control policies might need to be revised worldwide, refocusing on efforts to lower overall population-level consumption.Peer reviewe

Early Implant Placement with Immediate Loading in the Mandibular Anterior Region: A Rapid Solution to Edentulism

The aim of this article is to present the case of an early implant placement with immediate loading in the mandibular anterior region as a rapid solution to edentulism. A 40-year-old healthy male patient reported with a chief complaint of loosening of tooth in the lower front region of the jaw. On intraoral examination, there was a mobile tooth with respect to 41. The mobile tooth was extracted, and early implant placement was done along with Bio-Oss bone grafts to fill the jumping distance with no barrier membrane. Immediate provisionalisation was done on early-placed dental implants. After 5 months of the healing period, the final implant-level impressions were made, and the provisional crown was replaced with the final zirconia crown. This case report demonstrates satisfactory esthetic and functional outcomes along with various other advantages

Prevalence of Maxillary and Mandibular Frenal Attachment and Its Association with Age, Gender, and Oral Hygiene Status in Nepalese Population Seeking Dental Treatment

Objective. Frenum attachments are folds of mucous membrane that connect the lips to the alveolar mucosa and underlying periosteum. Aberrant positioning of the maxillary and mandibular labial frenum can lead to various clinical issues, including mucogingival problems and midline diastema. The objective of this study was to assess the prevalence of maxillary and mandibular frenal attachments and their association with age, gender, and oral hygiene status in the Nepalese population seeking dental treatment. Materials and Methods. This descriptive cross-sectional study was conducted over a period of 6 months, from February 2023 to August 2023, among patients visiting the Department of Periodontology and Oral Implantology, aged 6 years and above, after obtaining official permission from the Institutional Review Committee (IRC-KUSMS Approval No. 8/23). The study collected data on morphological variations of frenal attachment and various periodontal parameters such as Oral Hygiene Index-Simplified (OHI-S), pocket depth, recession, and midline diastema in both arches. Descriptive statistics, including frequency and percentage, were used to analyze the data. The χ2-test was employed to determine the correlation between gender and types of frenulum attachment, while analysis of variance was used to assess the association of frenal attachments with oral hygiene status. Results. Among 380 patients, the prevalence of frenal attachment was as follows: gingival 248 (65.30%), mucosal 71 (18.70%), papillary 42 (11.10%), and papillary penetrating 19 (5.00%) in the maxilla, and mucosal 225 (59.20%) and gingival 155 (40.78%) in mandible. Among the different morphological variations of frenal attachments, normal frenum was the most common, accounting for 231 cases (60.80%), followed by frenum with a nodule, with 101 cases (26.60%). Conclusions. The study found significant associations between frenal attachment and gender, as well as oral hygiene status. The prevalence of frenal attachments in this study was comparable to findings from previous research

Pharmacy practice in emergency response during the COVID-19 pandemic : lessons from Australia

The purpose of this paper is to provide an overview of the pharmacy practice and initiatives taken by the Australian federal government to ensure the continued supply of essential medicines under the conditions of an emergency response plan for COVID-19. During the pandemic, Australian pharmacists have been working collaboratively with multidisciplinary teams at the frontline to manage the equitable and safe supply of medicines despite the unprecedented situation. Although these presented problems for small pharmacies, social distancing policies were implemented widely to maintain personal and environmental hygiene and reduce the number of face-to-face patient visits. In collaboration with various pharmaceutical stakeholders, the Australian government responded rapidly to ensure equitable and sufficient supply with continued access to therapeutic goods during the pandemic. Additionally, vital policies and practices have been implemented, including supplying regular medicines at government-subsidized prices, a maximum one-month supply of some prescription medicines and purchase limits on over-the-counter medicines (one unit per purchase), medication management reviews through telehealth, electronic and digital prescribing, home delivery of medicines to vulnerable people and those in home isolation and the provision of serious shortage medicine substitution rights to pharmacists. Pharmacists were encouraged to communicate and collaborate with other local pharmacies to ensure that essential pharmacy services met community needs (e.g., opening hours). However, there has been a shortage of some medicines due to supply chain disruption and increased demand due to the pandemic. Higher demand for flu vaccinations, increased work pressure in pharmacies, and severe frustration and anxiety in pharmacy customers were also reported. Vigilance is required to monitor foreseeable shortages of therapeutics goods, particularly in regional pharmacies. There is an opportunity for long-term change to retain certain rights and roles based on the competence shown by pharmacists in this challenging period, such as telephone medication reviews, telehealth for MedsCheck and Diabetes MedsCheck, digital prescription handling and therapeutic substitution

A comprehensive study of electrode compression effects in all vanadium redox flow batteries including locally resolved measurements

Graphite felts are the most commonly used electrode materials in vanadium redox flow batteries. In the conventional cell design, flat sheets of graphite bipolar plates and porous graphite felts are stacked without any bonding, which requires a certain degree of compression to minimize the contact resistance. Excessive compression of the electrode, however, leads to non-uniform flow distribution and potential occurrence of zones with the retarded flow of electrolyte. This study investigates a wide range of electrode compressions and their effect on the cell performance. The results show that a compression of 25% is the optimal trade-off between contact resistance, homogeneity of flow distribution and pumping losses. Moreover, spatially resolved measurements using a segmented cell are employed to visualize the flow distribution across the electrode in real time. The open circuit voltage after the termination of the cell charge/discharge is converted to the corresponding state of charge (SOC) of the electrolyte, and the difference between the theoretical and experimental state of charge of electrolyte is used to quantify the flow distribution across the electrode. The results show that the optimum conversion of the reactant can be achieved during a single pass at 25% electrode compression. This method of segmentation is simple and scalable to any size of the battery.Accepted versionThis research was financially and technically supported by Nanyang Technological University, Singapore, and SGL Carbon GmbH, Germany

In‐situ tools used in vanadium redox flow battery research - review

Progress in renewable energy production has directed interest in advanced developments of energy storage systems. The all‐vanadium redox flow battery (VRFB) is one of the attractive technologies for large scale energy storage due to its design versatility and scalability, longevity, good round‐trip efficiencies, stable capacity and safety. Despite these advantages, the deployment of the vanadium battery has been limited due to vanadium and cell material costs, as well as supply issues. Improving stack power density can lower the cost per kW power output and therefore, intensive research and development is currently ongoing to improve cell performance by increasing electrode activity, reducing cell resistance, improving membrane selectivity and ionic conductivity, etc. In order to evaluate the cell performance arising from this intensive R&D, numerous physical, electrochemical and chemical techniques are employed, which are mostly carried out ex situ, particularly on cell characterizations. However, this approach is unable to provide in‐depth insights into the changes within the cell during operation. Therefore, in situ diagnostic tools have been developed to acquire information relating to the design, operating parameters and cell materials during VRFB operation. This paper reviews in situ diagnostic tools used to realize an in‐depth insight into the VRFBs. A systematic review of the previous research in the field is presented with the advantages and limitations of each technique being discussed, along with the recommendations to guide researchers to identify the most appropriate technique for specific investigations.Published versio

Novel Approaches for Solving the Capacity Fade Problem during Operation of a Vanadium Redox Flow Battery

The vanadium redox flow battery (VRFB) is one of the most mature and commercially available electrochemical technologies for large-scale energy storage applications. The VRFB has unique advantages, such as separation of power and energy capacity, long lifetime (>20 years), stable performance under deep discharge cycling, few safety issues and easy recyclability. Despite these benefits, practical VRFB operation suffers from electrolyte imbalance, which is primarily due to the transfer of water and vanadium ions through the ion-exchange membranes. This can cause a cumulative capacity loss if the electrolytes are not rebalanced. In commercial systems, periodic complete or partial remixing of electrolyte is performed using a by-pass line. However, frequent mixing impacts the usable energy and requires extra hardware. To address this problem, research has focused on developing new membranes with higher selectivity and minimal crossover. In contrast, this study presents two alternative concepts to minimize capacity fade that would be of great practical benefit and are easy to implement: (1) introducing a hydraulic shunt between the electrolyte tanks and (2) having stacks containing both anion and cation exchange membranes. It will be shown that the hydraulic shunt is effective in passively resolving the continuous capacity loss without detrimentally influencing the energy efficiency. Similarly, the combination of anion and cation exchange membranes reduced the net electrolyte flux, reducing capacity loss. Both approaches work efficiently and passively to reduce capacity fade during operation of a flow battery system

Optimization of thermal oxidation of electrodes for the performance enhancement in all-vanadium redox flow betteries

Thermal oxidation of a graphite felt in air is the most widely used electrode activation method to enhance the performance of a vanadium redox flow battery. It has been reported extensively, but almost all previous studies used individual treatment protocols with only few parameter variations. In this paper, treatment time and temperature were varied systematically along with in-depth physicochemical and electrochemical analysis. Prolonged treatment time is chosen for oxidation at lower temperatures aiming at low material loss rates, whereas shorter periods are applied at higher treatment temperatures, which are associated with elevated material loss. Among the electrodes treated with various protocols, the best performance is observed with electrodes oxidized at 750 C for 5 min. This study is important for both, reproducibly preparing samples at lab scale as well as commercial developers, where optimized and cost-effective pretreatment plays a significant role.Accepted versionThis research was financially and technically supported by Nanyang Technological University, Singapore, and SGL Carbon, Germany